Calcified pulmonary emboli as a late complication of the arterial switch operation
Bibliographic record
Abstract
A 24-year-old woman presented with 8-week history of recurrent left pleuritic chest pain, shortness of breath, and hemoptysis. Past medical history was significant for d-transposition of the great arteries, repaired with an arterial switch operation at birth, followed by homograft patch repair of the stenotic pulmonary trunk during childhood. CT pulmonary angiogram showed a large calcified mass in the pulmonary trunk (Panel A, solid arrow) with chronic emboli to segmental pulmonary arteries bilaterally (Panels B and C, dotted arrows; Supplementary data online, Videos S1) and left pleural effusion Panel B, asterisk). The large central mass also caused subtotal occlusion to the left lung, reducing perfusion to 5% on nuclear perfusion scan (Panels Di–ii). Despite these findings, right ventricular systolic pressure was estimated to be normal at echocardiography. Formal right heart catheterization was deemed inadvisable in the presence of the central pulmonary artery mass. The patient subsequently underwent removal of the central mass and endarterectomy of the calcified fragment in the right lower lobe artery (Panels B and C, circle). The excised central mass (Panel E) was firmly attached to the pericardial patch used to repair the main PA at the previous operation. Histology demonstrated predominantly calcified material (Panel F, solid arrow) with chronic thrombus and small focal areas of fibrotic tissue (Panel F, dotted arrow). To our knowledge, this is the first reported case of calcific pulmonary emboli related to prior congenital cardiac repair. The implanted homograft the patient received in childhood likely served as the nucleation site for thrombosis. The long interval between surgery and complication, along with its rarity, translated to a very unusual diagnosis. MPA, main pulmonary artery; Ao, aorta; Rt, right; Lt, left. The authors of this manuscript would like to thank Dr Alon Vaisman for his help with the drafting and revisions of this manuscript. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".